Strategies for the prevention of volleyball related injuries.

Although the overall injury rate in volleyball and beach volleyball is relatively low compared with other team sports, injuries do occur in a discipline specific pattern. Epidemiological research has revealed that volleyball athletes are, in general, at greatest risk of acute ankle injuries and overuse conditions of the knee and shoulder. This structured review discusses both the known and suspected risk factors and potential strategies for preventing the most common volleyball related injuries: ankle sprains, patellar tendinopathy, and shoulder overuse.

Volleyball injuries: managing acute and overuse disorders.

Most volleyball injuries are related to blocking or spiking, both of which involve vertical jumps. The most common acute injuries include ankle and thumb sprains, and common overuse injuries include patellar and shoulder tendinitis, suprascapular neuropathy, and low-back injury. Symptoms will usually resolve with conservative treatment, which may include activity modification, such as reduced jump training or jumping on a sand surface, and technical instruction. Players who have significant symptoms from suprascapular neuropathy may require diagnostic electromyography and MRI before surgical decompression.

Common injuries in volleyball. Mechanisms of injury, prevention and rehabilitation.

Volleyball has become an extremely popular participation sport worldwide. Fortunately, the incidence of serious injury is relatively low. The sport-specific activity most commonly associated with injury is blocking. Ankle sprains are the most common acute injury. Recurrent sprains may be less likely to occur if an ankle orthosis is worn. Patellar tendinitis represents the most common overuse injury, although shoulder tendinitis secondary to the overhead activities of spiking and serving is also commonly seen. An unusual shoulder injury involving the distal branch of the suprascapular nerve which innervates the infraspinatus muscle has been increasingly described in volleyball players in recent years. Hand injuries, usually occurring while blocking, are the next most common group of injuries. Fortunately, severe knee ligament injuries are rare in volleyball. However, anterior crutiate ligament injury is more likely to occur in female players. Many of these injuries may be preventable with close attention to technique in sport-specific skills and some fairly simple preventive interventions.

A comparison of intraoral antimicrobial effects of stabilized stannous fluoride dentifrice, baking soda/peroxide dentifrice, conventional NaF dentifrice and essential oil mouthrinse.

The intraoral antimicrobial activity of four commercial oral products-conventional NaF dentifrice (Crest), baking soda/peroxide/NaF dentifrice (Mentadent), essential oil mouthrinse (Listerine) and SnF2 dentifrice (Crest Plus Gum Care)-have been compared in three test regimens. Formulations were compared for their ability to suppress the regrowth and apical extension of dental plaque following toothbrushing during thirty hours of non-brushing where products were used as oral rinses (30-hour plaque regrowth model). Formulations were also compared for their ability to suppress the colony-forming units (cfu) of facultative anaerobic bacteria sampled from buccal gingival surfaces following use (Gingival Surface Microbial Index-GSMI model). Lastly, formulations were compared for effects in suppressing the glycolytic metabolic activity and regrowth activity of in vivo-treated dental plaques sampled at various periods following topical use and incubated under controlled ex vivo conditions (Plaque Glycolysis and Regrowth-PGRM model). In thirty-hour plaque regrowth testing, the rank ordered antimicrobial efficacy of formulations followed SnF2 > essential oils > NaF = water = baking soda/peroxide. In GSMI testing, all formulations were shown to suppress the cfu of facultative anaerobic bacteria relative to baseline, although SnF2 treatment was observed to reduce bacterial levels to a significantly greater degree than NaF dentifrice or baking soda/peroxide dentifrice up to two hours following brushing. In PGRM testing, the SnF2 dentifrice provided significant inhibition of bacterial metabolism and regrowth following topical application when compared with the NaF dentifrice as control. The baking soda/peroxide dentifrice provided no reduction in either bacterial metabolism or regrowth in PGRM. Previous studies had demonstrated modest effects for essential oil rinse in reducing PGRM plaque regrowth, with no effects for this treatment on plaque metabolism. Overall, these results demonstrate that SnF2 dentifrice provides substantial intraoral antimicrobial effects. The essential oil mouthrinse also exhibits significant intraoral antimicrobial effects, albeit apparently less than SnF2 dentifrice. The baking soda/peroxide dentifrice did not produce any antimicrobial effects following in vivo use compared with conventional dentifrice. These results provide mechanistic rationale for the chemotherapeutic efficacy of SnF2 and essential oil formulations in reducing gingivitis, while providing no support for the expectation of clinical efficacy for formulations containing baking soda and peroxide.

Athlete age and sports physical examination findings.

BACKGROUND: Interscholastic and intercollegiate athletes commonly visit physician offices to have sports participation examinations (PPEs). Few data exist, however, to help determine the age range for which such examinations are reasonable. The purpose of this study was to determine the percentage of athletes with significant findings on sports PPEs among junior high school, high school, and college-age athletes. METHODS: Analyses were made of 937 consecutive PPEs that were performed by primary care physicians using a standardized form. Subjects were interscholastic athletes of junior high, high school, and college age. Significant findings were defined as those that resulted in any recommendation, ie, change in management, by the examining physician. RESULTS: The incidence of significant findings was 3.4% for the junior high school athletes, 15.4% for high school athletes, and 33.9% for college athletes (P < .001). The overall percentage of athletes disqualified from participating in any sport, which was 1.7%, did not differ significantly across age levels. CONCLUSIONS: In this sample, college and high school athletes were much more likely than junior high school athletes to have significant findings on sports. PPEs. These data cast uncertainty on the necessity of annual PPEs to screen athletes of junior high school age.

Comparative antimicrobial effectiveness of a substantive (0.12% chlorhexidine) and a nonsubstantive (phenolic) mouthrinse in vivo and in vitro.

Antimicrobial mouthrinses can play an important role in maintaining oral health by killing cariogenic organisms and preventing plaque and gingivitis. The active ingredients are adsorbed by oral tissues and then gradually released into the saliva. In this article, the effectiveness of a substantive chlorhexidine and a nonsubstantive phenolic antimicrobial mouthrinse were tested. When compared, the results indicated that the two types of mouthrinses are equally effective at killing salivary microbes for up to 30 minutes after rinsing. The prescriptive substantive rinse, however, continued its microbicidal effect for a longer duration (up to 5 hours) than the over-the-counter nonsubstantive rinse. The substantive rinse showed pronounced and measurable zones of inhibition around each well in the agar diffusion assay where the nonsubstantive rinse showed no zone around any well at any time. The substantive rinse also showed a superior ability to inhibit the growth of 28 oral microbes, including some putative periodontopathogens, which were assayed.

Physical allergies and exercise. Clinical implications for those engaged in sports activities.

There are several allergic responses that may occur in susceptible individuals as a result of exposure to physical stimuli. Most of these conditions are mediated by vasoactive substances and usually result in symptoms of urticaria and/or angioedema. There are 2 such conditions that may occur as a direct result from exercise. The first of these is cholinergic urticaria. Patients with cholinergic urticaria experience punctate (2 to 4mm) hives which occur reproducibly with exercise or with passive warming, such as might occur in a steam bath or hot pool. Life-threatening hypotension or angioedema usually do not occur with cholinergic urticaria. This condition usually responds well to oral hydroxyzine. Exercise-induced anaphylaxis (EIA) is a form of physical allergy that has been recognised with increasing frequency in recent years. This syndrome typically presents with generalised pruritus, a flushing sensation, a feeling of warmth and the development of conventional (10 to 15mm) urticaria in association with vigorous physical exertion only. Symptoms tend to occur variably with exposure to exercise and do not typically occur with passive warming. During symptomatic attacks, cutaneous mast cells degranulate and serum histamine levels increase. Treatment is problematic. Cessation of exercise with onset of symptoms and self-administration of epinephrine (adrenaline) are recommended. Other physical allergies that may affect exercising individuals include cold urticaria, localised heat urticaria, symptomatic dermatographism (dermographism), delayed pressure urticaria (angioedema), solar urticaria and aquagenic urticaria. Management of these conditions may include patient education, selective avoidance, antihistamines and, in some cases, induction of tolerance.

Introduction: exercise and allergy.

At a time when the American public is committed to health through exercise, a variety of allergic conditions related to activity are being recognized with increasing frequency. Conditions such as cholinergic urticaria, bronchospasm, and even anaphylaxis have occurred as a consequence of exercise. Thus, a symposium has been developed to examine the role of exercise in association with such conditions. Several of the physical allergies are discussed in overview fashion. Exercise-induced anaphylaxis, the most serious form of allergic response to exercise itself, is considered in greater detail. The etiology, clinical features, and therapy for these physical allergies are addressed. Exercise-induced bronchospasm (EIB) has been well categorized in the literature. This is another exercise-related condition with an allergic component. The current concepts with respect to proposed etiology, epidemiology, and clinical features are discussed. EIB is an important condition to screen for, and techniques for identifying patients who should be screened are also addressed. Allergic rhinitis may also affect athletes. Accurate diagnosis and effective management of all these conditions may help greater numbers of people to enjoy the full benefits of exercise.

Physical allergies.

Allergic responses that occur as a result of exposure to physical stimuli are discussed. Most of these conditions are mediated by vasoactive substances, resulting in urticaria and/or angioedema. Susceptible individuals who engage in athletic activities may place themselves at particular risk for these problems. The physical allergies include cholinergic urticaria, exercise-induced anaphylaxis, cold urticaria, dermatographism, solar urticaria, and aquagenic urticaria. Management of these conditions includes patient education, selective avoidance, antihistamines, and, in some cases, induction of tolerance.

Exercise-induced anaphylaxis.

Exercise-induced anaphylaxis (EIA) is a unique form of physical allergy that has been recognized with increasing frequency in recent years. The hallmarks of this syndrome are generalized pruritus with a flushing sensation, a feeling of warmth, and the development of urticaria in association with vigorous physical exertion. These symptoms tend to occur variably with exercise, but not with passive warming. Most patients report typical giant urticarial eruptions. Skin mast cells degranulate, and serum histamine increases during symptomatic attacks. Treatment is often problematic, but cessation of exercise with onset of symptoms and self-administration of epinephrine are recommended.

Case report: 30-yr-old female with exercise induced anaphylaxis.

This case describes a 30-yr-old white female who presented with a 2-wk history of pruritic rash with exercise. This rash occurred with each bout of exercise and was accompanied by one episode of light-headedness. A bicycle ergometer exercise challenge resulted in a fine wheal and flare rash of the trunk and upper extremities that was associated with symptomatic hypotension. She was diagnosed with exercise induced anaphylaxis, and initial treatment with hydroxyzine was instituted. Side effects from the drug were poorly tolerated, and she was switched to inhaled cromolyn sodium. She had noted resolution of her symptoms while she took cromolyn as recommended. Two months after her initial presentation, she also began to experience the same rash with hot showers. Exercise induced anaphylaxis is a well-described form of physical allergy that may be underdiagnosed. As the fitness boom continues and clinicians see more exercising patients, it will be important to recognize and understand this condition. It is a true anaphylactic reaction and, as such, certainly has the potential for significant morbidity and mortality.

Irrigation with chlorhexidine to resolve naturally occurring gingivitis. A methodologic study.

This study compared oral irrigation and rinsing with chlorhexidine (CHX) and placebo in the treatment of naturally occurring chronic gingivitis. 44 subjects with at least 6 interproximal sites which bled on probing were randomly distributed on a double-blind basis into 4 treatment groups, placebo-rinse, CHX-rinse (0.12%), placebo-irrigation and CHX-irrigation (0.06%). A half-mouth was scaled 2 weeks prior to therapy in all groups. Rinses were performed 2 times daily and irrigation was performed once a day by means of an oral irrigator with the tip directed at a right angle to the tooth. Subjects continued with routine oral hygiene without instruction. The active treatment period was 2 months. Parameters were recorded at baseline and at 60 days. At the conclusion, marginal plaque was cultured for predominant microbial types. CHX-rinse (0.12%) and CHX-irrigation (0.06%) significantly reduced (p less than 0.05) plaque. Gingival bleeding decreased by 26% in both scaled and unscaled sites following CHX (0.12%) rinses and by 40% at both types of sites following CHX (0.06%) irrigation. Bleeding was reduced with CHX-irrigation greater (p less than 0.05) than with the placebo-irrigation. The mean log of colony-forming units of Actinomyces species was significantly lower (p less than 0.05) in the CHX (0.12%) rinse and CHX (0.06%) irrigator groups than in the placebo groups. These data therefore indicate that delivery of CHX (0.06%) by an oral irrigator is an effective means of treating naturally occurring gingivitis.

Scrotal Injury in a High School Football Player.

In brief A high school football player who was kneed in the groin during a game sustained an injury to his right testicle. Surgical exploration revealed a large hematocele secondary to a transverse laceration. Treatment consisted of partial excision of the seminiferous tubules and primary closure of the tunica albuginea. He was allowed to return to football the following year but was advised to wear a protective cup.

Anteroinferior Tibiofibular Ligament Injury: Not Just Another Ankle Sprain.

In brief: Ankle sprains that primarily involve the anteroinferior tibiofibular ligament are reportedly uncommon, but the authors have recently seen several such injuries in their clinic. These high ankle sprains usually are caused by forced lateral rotation with the foot in dorsiflexion. Edema and ecchymosis are generally minimal, with pain and tenderness over the distal anterior tibiofibular syndesmosis. Pain and disability can persist for weeks. Rehabilitation consists of range-of-motion exercises leading up to weight-bearing and often takes much longer than the initial symptoms might suggest.

Shinsplints.

Shinsplints is not a specific diagnosis; it is a general term encompassing several conditions that result in chronic leg pain. Some recent advances, particularly the use of bone scan, have improved the diagnosis of shinsplints. Physicians dealing with these problems should refer to specific anatomic and etiologic conditions rather than use the term shinsplints. This will not only improve communication but also permit more accurate direction of therapy.